A new study presented at the 14th Congress of the European Federation of Neurological Societies (EFNS) strongly supports earlier findings about treatment efficacy of combination therapy. The research showed that, when treating Alzheimer's disease, a combination of a cholinesterase inhibitor like Aricept plus Namenda is significantly better than mono-therapy with a cholinesterase inhibitor only.

In this study of more than 400 patients with moderate to severe Alzheimer's disease, significant improvements in patients receiving combined therapy were noted in cognition, function, behavior, global outcome, and care dependency. These are robust findings that might begin to change nihilistic attitudes toward Alzheimer's treatment.

The most optimistic view of treatment efficacy comes not only from studies like this, showing the benefits of combo-therapy, but from a more robust approach. To maximize treatment effect, we need to intervene earlier in the disease process so that patients can start therapy before massive neuron death and synapse loss occurs. Additionally, we need to augment the benefits of drug treatment with a balanced diet, physical activity, and proper control of other co-morbid conditions such as diabetes ad hypertension. Most probably, staying intellectually active and socially engaged is also beneficial.

Given the generally defeatist tone of most press about Alzheimer's treatment, I am happy to see the occasional positive press about our ability to combat this disease. We have a long way to go but the facts are more comforting than most headlines suggest.--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Amid the stream of press about memory loss, there is an obvious focus on Alzheimer's disease. There is less prevalent coverage of other memory-impairing medical conditions such as depression and thyroid disorders, to name a couple. However, there is scant attention paid, and in fact few online resources that I have located, focused on medications that are known to impair memory.

I noticed this short story atNewTimes.com and I thought it should be shared. It is written by Dr. Beata Skudlarska, a geriatrician in Bridgeport, Connecticut.

While the article largely debunks the notion that Lipitor and other statins cause memory loss, the author recognizes that there is evidence of such side effects in about 2% of the population. More importantly, the article names other specific drugs that are known to be associated with memory disturbances.

Reference is made to certain drugs in all of the following categories:

Tranquilizers

Anti-depressants

Anti-psychotics

Pain killers and muscle relaxants

Stimulants

Reference is also made to certain drugs for treating the following conditions:

Upset stomach

Incontinence

Allergies

Stomach Cramps

Allergies

Seizures

Asthma

Arthritis

Inflammation

It is a short article, it is well written, and doesn't appear to be selling anything other than expert medical advice. If you have any memory concerns that you think might be related to medications you take, I recommend you follow this link and read it.--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

The LA Times published a nice article today summarizing what we know about mental and physical exercise with regards to the benefits that accrue to cognitive health.

Articles of this nature are commonly written with a commercial agenda, touting exaggerated claims that have not been adequately validated through scientific study. I have chosen to highlight this article because it was well written and objective in its presentation. I think it does a good job in separating unproven claims from those with varying degrees of scientific evidence.

We know that physical exercise is generally beneficial to overall health, including cognitive health. We also know that exercising your brain, through challenging new learning, is surely not bad and most probably beneficial. But be aware, many vendors of computerized workouts claim benefits that are yet unproven. Others are accumulating scientific evidence suggesting that their products may improve mental sharpness. It certainly stands to reason that forcing your brain to learn and to establish new synaptic circuitry is probably somehow helpful. You should simply be aware that not every claim you find online is well backed with evidence.

The bottom line: staying active (both mentally and physically), is a good bet in maintaining a high level of health and a good quality of life.--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Contributed by: Dennis Fortier, President, Medical Care Corporation
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We know that Alzheimer's is a complex disease encompassing an interactive cascade of pathological processes. Understanding those processes, the mechanisms that trigger them, and beneficial ways to intervene against them, are all topics of intense scientific scrutiny.

This week, that scrutiny uncovered another piece of the puzzle and created a new challenge to understand where and how it fits into the bigger picture.

Research conducted at the University of Miami, and published in PLoS Genetics, showed that variations in the MTHFD1L gene were highly correlated with Alzheimer's disease. In fact, those with a specific variation were about twice as likely to develop Alzheimer's disease as those without it.

This gene also plays a role in regulating the body's level of homocysteine, an amino acid affecting cell metabolism. This discovery seems integral in understanding Alzheimer's because, aside from the high correlation between the genetic variant and the presence of disease noted in this study, high levels of homocysteine were already known to be a risk factor for the Alzheimer's.

As suggested by the headline of this post, this scientific advance provided no new answers; it only uncovered another piece of the puzzle that must be fit into the complete picture before we can fully understand how best to intervene against Alzheimer's. Nonetheless, it is exciting because we cannot hope to fit the puzzle together until all the pieces are in hand, and this is another small but important step toward that end.--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Today is World Alzheimer's Day. It is a designation aimed at raising awareness about a major threat to the health of the worldwide population and to the economies of our nations.

Last fall, during National Alzheimer's Awareness Month, I wrote an article titled: Alzheimer's Awareness: Why Bother? The article makes the case for how awareness translates into real world gains in our ability to identify, diagnose and treat this complex disease. To my surprise and delight, the article was read about 80,000 times in the 24 hours after I posted it.

I am linking back to that post today in the hope of spreading the educational message a little more broadly on this important day.

--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

As scientists push forward to understand the underlying mechanisms of Alzheimer's disease, insights are emerging from many fronts. The disease is complex and the facts discerned by each new discovery must be assembled into an ever evolving theory.

This week, research conducted at the University of Washington and published in the journal PLoS Genetics, indicated a strong link between a specific genetic variant, a higher level of tau protein, and more rapid disease progression. These findings are well aligned with the tau hypothesis that abnormalities associated with tau proteins are a key driver Alzheimer's pathology.

While it is not clear how this research, if validated, will be integrated into a more comprehensive understanding of the disease, it certainly seems integral. It may lead to new treatment targets with agents that regulate tau production; it may lead to diagnostic approaches to identify patients at risk of rapid progression; and it may lead to a more generally robust understanding of the entire pathological process.--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Contributed by: Michael Rafii, M.D., Ph.D - Director of the Memory Disorders Clinic at the University of California, San Diego. ______________________________________

Brain atrophy involves the loss of neurons. Some degree of atrophy and subsequent brain shrinkage is common with old age, even in people who are cognitively healthy. However, this atrophy is accelerated in people with mild cognitive impairment and even faster in those who ultimately progress from mild cognitive impairment to Alzheimer’s disease. Many factors have been implicated in affecting the rate of brain atrophy, one of which is high levels of an amino acid in the blood called homocysteine. Studies have shown that raised levels of homocysteine increase the risk of Alzheimer’s disease.

In a recent randomised controlled trial, researchers investigated the role of vitamin B in regulating levels of homocysteine. They specifically wanted to test whether lowering homocysteine through giving high doses of vitamin B for two years could reduce the rate of brain atrophy in people with pre-existing mild cognitive impairment.

It was specified that volunteers should have a diagnosis of mild cognitive impairment (MCI), defined using specific criteria. These included a concern about memory that did not interfere with activities of daily living and pre-specified scores on some cognitive scales assessing word recall and fluency. Every six months, the volunteers were randomly assigned to receive either high-dose oral vitamin B tablets (0.8 mg folic acid, 0.5 mg vitamin B12 and 20 mg vitamin B6) or placebo pills during the two-year period. The participants, their partners and all staff directly involved in the study were unaware which pills were being received. The double blind nature of the study was important as it eliminated potential biases associated with the patients’ or researchers’ knowledge of which treatment was being received. MRI scans were performed at the start of the study and again after two years. The researchers used these to calculate the rate of brain atrophy each year.

For the main analysis of brain shrinkage, the researchers used data on 168 people (85 receiving active treatment and 83 receiving placebo) who had completed an MRI at both the start and at follow-up. The analyses took into account a variety of factors that may be linked to brain atrophy or use of vitamin B, which the researchers had tested and found to be important. These factors were age, blood pressure, initial brain volume and concentration of homocysteine at the start of the study. Treatment with vitamin B tablets had notable effects on the levels of homocysteine in the blood, reducing it by 22.5%. Levels of homocysteine increased by 7.7% in the placebo group. Overall, treatment with B vitamins for a period of 24 months led to a reduction in the rate of brain atrophy. After the age of the participants was taken into account, the rate of shrinkage in people receiving the vitamins was 30% less than in the placebo group (0.76% shrinkage and 1.08% shrinkage respectively). The effect was greater in people who were more compliant with taking their medication and in those who started with the highest levels of homocysteine.

This is an important but early study in establishing the effects of vitamin B on the stages of brain atrophy that precede Alzheimer’s disease. It assessed the effects of the vitamin on the rate of brain shrinkage, a process that has been linked to old age, mild cognitive impairment and Alzheimer’s disease in other studies.

This study will pave the way for future research into the use of vitamin B to prevent Alzheimer’s disease. Based on the evidence gathered so far, it is too early to claim that vitamin B can prevent clinical disease, but these results are promising. It is also interesting to note that this is a major study that exemplifies the use of potential biomarkers such as imaging, in therapeutic trials for MCI and aging.

--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

These days, with specialized news coverage, it is easy to track a technical story, nuance by nuance, and eventually drift away from the fact that we might not really understand the underlying foundation of knowledge that makes the story important. I think this is commonly the case with stories about the brain.

It is a complex organ and our understanding of how it works, despite tons of progress, remains nascent. Hopefully, some will appreciate this link to a great piece by National Geographic.

This is for any readers who would like to go back to basics and refresh themselves about the structure and function of that three-pound organ that makes us human.

--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Contributed by: Dennis Fortier, President, Medical Care Corporation
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A new study published in Neurology is driving lots of press coverage about gender differences as they pertain to subtle memory loss.

In the past, studies on the prevalence of dementia, a much more severe condition than subtle memory loss, have shown that incidence increases with age. Given the relatively longer life span of women, there has been no surprise that a higher percentage of women eventually become demented compared to men. This knowledge contributed nothing to the question about whether or not there is a gender difference at earlier symptomatic stages of decline.

In other studies, it has been clearly established that cardiovascular health is closely linked to cognition. Higher rates of hypertension in men suggested that direct gender comparisons would need to adjust for this confounding information before drawing conclusions. However, it is difficult to quantify the specific cognitive impact across a range of vascular factors and other demographic variables, so little could be concluded about absolute gender differences.

Now, in a study of 2000 seniors, researchers at the Mayo Clinic have made a puzzling discovery. Men seem to be about 50% more likely than women to suffer from mild cognitive impairment, even when accounting for age, education, and cardiovascular health factors.

This surprising finding cannot be attributed to differences in longevity or incomparable levels of vascular risk. If these findings are duplicated and substantiated, they may suggest important, gender-based differences in cognitive health. Ultimately, this could point the way to promising new avenues of research in the quest to understand and treat degenerative disorders like Alzheimer's disease.

--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

As an avid reader of the press coverage of the Alzheimer's and dementia space, I am aghast at how inaccurately many stories are reported. This has been my motivation for editing this blog and for writing educational series like "How to Read the News". Some stories are so consistently mis-characterized in the press, even by respected sources, that it makes me question the quality of everything I read.

Last week, a completely unsurprising study was published in the journal Neurology. It showed evidence of a phenomenon that was already widely reported and well accepted, yet the coverage of the story has been twisted and sensationalized beyond recognition.

I am speaking of the study that showed how mental activity is most likely helpful in maintaining cognitive function. However, many notable media sources opted to frame the finding in a sensational light with headlines suggesting that mental activity is detrimental to cognitive health.

Both of these would leave a headline scanner with the notion that using your brain may be, in some way, harmful to your cognitive health. In the second story, NPR was pretty clear about the finding but, given the overall poor quality of reporting on this study, I think the headline was reckless and lent itself to misinformation.

U.S. News and World Report
Headline: Mental Activity Linked to Alzheimer's Decline

This headline shows a bit more editorial constraint, making a less clear connection between mental activity and poor cognitive health, but it suggests a pernicious relationship. I would expect more from the LA Times.

Much like the NPR headline, this strongly suggests that exercising your brain may be bad for your cognitive health. It's unconscionable.

Fortunately, not every source leapt at the opportunity to use wild sensationalism as a hook to attract readership. Businessweek got it right twice with two honest headlines on their coverage and the Washington Post was accurate as well. Neither publication emphasized the optimistic finding that brain exercise might allow you to maintain sharp thinking skills, but at least they were honest. Here are their headlines:

The point of the Brain Today blog is to read the news with a critical eye and to lend perspective to the news and to the way the news is reported. It is unfortunate, but you really need to read with a discerning focus to keep from being led astray by the popular press. This blog aims to help you with that effort.

--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Does mental activity accelerate cognitive decline for people with Alzheimer's disease? Of course not. But to read the headlines over the past two days, one could be excused for wondering.

Contradictory Study?
A study published yesterday in Neurology noted that, among demented subjects with AD, those who had a history of high cognitive activity like reading, doing crosswords, and visiting museums, declined at an accelerated pace. On the surface, this seems contradictory to the notion that exercising your brain preserves mental function. A closer look, however, reveals an obvious and consistent conclusion.

This study demonstrates that, most probably, maintaining a high level of mental activity allows subjects with progressing Alzheimer's pathology, to continue functioning at a high cognitive level, even as the lesions accumulate in their brains. This means that those who remain mentally active may not manifest symptoms until they have very extensive damage in their brains. If so, symptoms will first appear in these subjects at a later, more pathologically severe stage. As such, there is little wonder that the decline seems more rapid for these subjects.

Delay and Compression of Symptoms
A good way to look at it is this: We don't see an acceleration of decline, but rather, a delay and compression of decline, into the final stages of the disease.

To illustrate this point, consider a typical course of decline between a mentally active person and a mentally inactive person. The inactive person may show subtle symptoms for 5 years, moderate symptoms for five years, and severe symptoms for five years, across a 15-year disease course. The mentally active person might show no symptoms for the first ten years of disease and then degrade quickly to severe symptoms during the final five years. Both had a 15 year disease course but the mentally active person showed no symptoms for the first ten. That person appeared to decline more rapidly, but actually declined much slower (perhaps not at all) during ten of the 15 years. In the broad context, the active person was certainly far better off across the full course of decline.

Many of the headlines on this study are sensationalistic and misleading. I thought this coverage from Bloomberg/Business Week was well done and represented the facts quite fairly.

--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

This is an exciting story but needs to be embraced with proper expectations. The New York Times is reporting on research scheduled to publish tomorrow in Nature, that a promising new target has been identified for treating Alzheimer's disease.

The target is a protein that activates the role of gamma secretase in producing beta amyloid in the brain. Following the recent failure of Eli Lilly's phase III drug that inhibited gamma secretase, and the ensuing round of questions that the failure spawned about the validity of the amyloid hypothesis, this is fantastic news.

This finding points to a potential refinement of current thinking. It is clear that gamma secretase has multiple roles, some of which are neuro-protective and others which lead to overproduction of beta amyloid. As a treatment hypothesis, we are aiming to reduce the production of beta amyloid but inhibiting gamma secretase is apparently too crude of an approach. It seems as though the downside of inhibiting gamma secretase is greater than the upside, and two drugs based on that approach, have previously failed to show clinical benefits.

With the discovery of this new protein, it is suggested that we might be able to turn off the harmful activities of gamma secretase while allowing its beneficial activities to continue. This portends great hope.

One word of caution, to which I alluded in the opening. This science is a long way from being validated which is only the first step in a long FDA process to commercialization. If this discovery eventually turns out to be part of an effective treatment, that treatment is still many years from commercial availability.

--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.